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Kōbe-shi, Japan

Inoue N.,Kobe Rosai Hospital
Journal of Atherosclerosis and Thrombosis | Year: 2014

Recent major advances in medical science have introduced a wide variety of treatments against atherosclerosis- based cardiovascular diseases, which has led to a significant reduction in mortality associated with these diseases. However, atherosclerosis-based cardiovascular disease remains a leading cause of death. Furthermore, progress in medical science has demonstrated the pathogenesis of cardiovascular disease to be complicated, with a wide variety of underlying factors. Among these factors, stress is thought to be pivotal. Several types of stress are involved in the development of cardiovascular disease, including oxidative stress, mental stress, hemodynamic stress and social stress. Accumulating evidence indicates that traditional risk factors for atherosclerosis, including diabetes, hyperlipidemia, hypertension and smoking, induce oxidative stress in the vasculature. Oxidative stress is implicated in the pathogenesis of endothelial dysfunction, atherogenesis, hypertension and remodeling of blood vessels. Meanwhile, mental stress is a well-known major contributor to the development of cardiovascular disease. The cardiovascular system is constantly exposed to hemodynamic stress by the blood flow and/or pulsation, and hemodynamic stress exerts profound effects on the biology of vascular cells and cardiomyocytes. In addition, social stress, such as that due to a lack of social support, poverty or living alone, has a negative impact on the incidence of cardiovascular disease. Furthermore, there are interactions between mental, oxidative and hemodynamic stress. The production of reactive oxygen species is increased under high levels of mental stress in close association with oxidative stress. These stress responses and their interactions play central roles in the pathogenesis of atherosclerosis-based cardiovascular disease. Accordingly, the pathophysiological and clinical implications of stress are discussed in this article. Source

Inui Y.,National Hospital Organization Kobe Medical Center | Miyamoto H.,National Hospital Organization Kobe Medical Center | Sumi M.,Kobe Rosai Hospital | Uno K.,National Hospital Organization Kobe Medical Center
Spine | Year: 2011

Study Design.: Retrospective clinical analyses of patients with cervical spondylotic amyotrophy (CSA). Objective.: To report the clinical outcomes and predictive factors relating to the prognosis in conservative and surgical treatments for CSA. Summary OF Background Data.: CSA is a clinical entity characterized by muscle atrophy in the upper extremity without marked sensory disturbance or spastic tetraparesis. The indications for, and outcomes of conservative and surgical treatments for CSA have not been clearly enunciated. Methods.: Ninety patients with CSA were enrolled in this study. All of them initially received continuous cervical traction for 2 to 3 weeks as inpatients. If this conservative treatment was ineffective, surgical intervention was carried out after informed consent was obtained. We investigated the outcome of conservative treatment, the predictive factors relating to the prognosis of the conservative treatment, and the outcome of surgery after initial conservative treatment failed. Results.: After initial conservative treatment, 42 patients (46.7%) showed excellent or good outcome, 29 patients underwent surgery, and 19 patients declined surgery. Consequently, 61 patients were conservatively followed up. At final follow-up, 40% of the patients still showed excellent or good neurologic status by conservative treatment, and this group was characterized by age <50 years, duration of symptoms <6 months, single-level stenosis, foraminal stenosis, and a good response to traction therapy. Additional 5 patients underwent surgery during follow-up because of deterioration of symptom, and 34 patients consequently underwent surgery at the final follow-up. Of 34, 28 (82%) patients who underwent surgery obtained neurologic improvement. Conclusion.: The present study has demonstrated the outcome of conservative and of surgical treatments for CSA, together with the predictive factors relating to the prognosis. Conservative treatment should be initially tried on CSA patients, especially those with predictive factors relating to a better prognosis. However, if conservative treatment failed, surgical intervention was successful. Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Source

Miyamoto H.,National Hospital Organization Kobe Medical Center | Sumi M.,Kobe Rosai Hospital | Uno K.,National Hospital Organization Kobe Medical Center
Spine Journal | Year: 2013

Background context: Surgical intervention is a therapeutic choice for atlantoaxial subluxation (AAS), vertical subluxation (VS), and subaxial subluxation (SAS) associated with rheumatoid cervical spine. However, the long-term outcomes of different subgroups remain unclear, although rheumatoid arthritis (RA) is a progressive disease even after surgery. Purpose: To evaluate the outcomes of surgery for various subgroups of rheumatoid cervical spine, performed at a single institute over three decades. Study design: Retrospective clinical analysis. Patient sample: One-hundred eighteen seropositive RA patients treated at one institute over the past three decades. Atlantoaxial fixation was performed in 28 AAS patients. Occipitospinal fusion was performed in 41 irreducible AAS or VS patients. Laminotomy with autologous bone fusion was performed in 22 patients, anterior fusion in 5, laminoplasty in 4, and posterior decompression/fusion with instrumentation in 12 with SAS. Methods: Clinical outcomes using the Japanese Orthopedic Association score, complications, deterioration of RA, and mortality rate during the follow-up were investigated from preoperation to more than 10 years after surgery in the subgroups. Outcome measures: Outcomes were compared among the subgroups. Results: Patients with AAS exhibited significantly better clinical outcomes throughout the follow-up period compared with patients from the other subgroups. Patients with SAS had the worst neurologic status even at preoperation, and the symptomatic improvement achieved by surgery deteriorated within less than 5 years. Deterioration of outcome was caused by occurrence of complications and deterioration of RA during the follow-up. The mortality rates at 5 and 10 years after surgery were 20% and 33%, respectively. Conclusions: The outcome of surgery for rheumatoid cervical spine was different in the various subgroups and associated with the occurrence of complications and deterioration of RA. © 2013 Elsevier Inc. All rights reserved. Source

Honjo T.,Kobe University | Yamaoka-Tojo M.,Kitasato University | Inoue N.,Kobe Rosai Hospital
Current Vascular Pharmacology | Year: 2011

The renin-angiotensin system (RAS) plays an essential role in fluid and electrolyte homeostasis and the regulation of vascular tone; however, dysregulation and over-activation of the RAS lead to the pathogenesis of various cardiovascular diseases. The RAS is closely associated with NADPH oxidase, a major enzymatic source of reactive oxygen species (ROS) in vasculature, and angiotensin II, the final effecter of the RAS, is a potent stimulator of this oxidase. There are accumulating evidences to support the significance of NADPH oxidase in the pathogenesis of atherosclerosis. We demonstrated that the expression of NADPH oxidase is markedly enhanced in human atherosclerotic coronary arteries, and the distribution of oxidized oxidized low-density lipoprotein (LDL) in vasculature is closely associated with NAPDH oxidase and ROS. Our series of observations indicate there is a vicious circle consisting of vascular NADPH oxidase, the RAS, ROS, and oxidized LDL. Furthermore, we demonstrated that angiotensin II type 1 receptor blockers (ARBs) significantly suppressed the expression of NADPH oxidase p22 phox in the aortic walls of patients with thoracic aortic aneurysm. ARBs, widely used for treatment of hypertension and hypertension-related organ damage, have succeeded in reducing the onset of cardiovascular diseases, preventing organ damage, and cardiac death. These beneficial effects of ARBs are largely dependent upon their primary effects of blood pressure lowering. However, this group of agents exerts a wide variety of biological effects on vascular metabolism, including antioxidative and anti-inflammatory actions. These pleiotropic actions play a role in cardiovascular protection. From a viewpoint of oxidative stress, we discuss pleiotropic effects of ARBs on vascular metabolism focusing on pathogenesis of atherosclerosis-based cardiovascular diseases. © 2011 Bentham Science Publishers Ltd. Source

Miyamoto H.,Kinki University | Maeno K.,Kobe University | Uno K.,Kobe medical center | Kakutani K.,Kobe University | And 2 more authors.
European Spine Journal | Year: 2014

Purpose: The surgical strategy for cervical spondylotic myelopathy (CSM) accompanying local kyphosis is controversial. The purpose of the present study was to compare and evaluate the outcomes of two types of surgery for CSM accompanying local kyphosis: (1) laminoplasty alone (LP) and (2) posterior reconstruction surgery (PR) in which we corrected the local kyphosis using a pedicle screw or lateral mass screw. Methods: Sixty patients who presented with local kyphosis exceeding 5 were enrolled. LP and PR were each performed on a group of 30 of these patients; 30 CSM patients without local kyphosis, who had undergone LP, were used as controls. The follow-up period was 2 years or longer. Preoperative local kyphosis angles in LP and PR were 8.3 ± 4.4 and 8.8 ± 5.7, respectively. Preoperative C2-7 angles in LP, PR and controls were -1.7 ± 9.6, -0.4 ± 7.2 and -12.0 ± 5.6, respectively. The recovery rate of the JOA score, local kyphosis angle and C2-7 angle at post-op and follow-up were compared between the groups. Results: The recovery rate of the JOA score in the LP group (32.6 %) was significantly worse than that in the PR group (44.5 %) and that of controls (53.8 %). Local kyphosis angles in the PR and LP groups at follow-up were 4.0 ± 8.6 and 8.0 ± 6.0, respectively. However, although the C2-7 angle at follow-up was improved to -11.1 ± 12.7 in PR, and maintained at -11.6 ± 6.2 in controls, it deteriorated to 0.5 ± 12.7 in LP. Conclusions: The present study is the first to compare the outcomes between LP alone and PR for CSM accompanying local kyphosis. It revealed that PR resulted in a better clinical outcome than did LP alone. This result may be due to reduction of local kyphosis, stabilization of the unstable segment, and/or the maintenance of C2-7 angle until follow-up in the PR group. © 2013 Springer-Verlag Berlin Heidelberg. Source

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